Healthcare Provider Details

I. General information

NPI: 1063328136
Provider Name (Legal Business Name): M L REARDON MSW LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S VAL VISTA DR STE A3-686
GILBERT AZ
85296-1374
US

IV. Provider business mailing address

70 S VAL VISTA DR STE A3-686
GILBERT AZ
85296-1374
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-0175
  • Fax:
Mailing address:
  • Phone: 480-269-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MARLYS L REARDON
Title or Position: OWNER/THERAPIST
Credential: MSW, LCSW, PMH-C
Phone: 480-269-0175